OBJECTIVE:Depression and anxiety are common during pregnancy, but the prevalence of antidepressant use during pregnancy in Switzerland is not well documented. We explored antidepressant use before, during, and after pregnancy in Switzerland. METHODS:We conducted a descriptive study using a Swiss health care insurance claims database (Helsana) between 2015 and 2021. We included pregnancies resulting in birth of women who were continuously insured during three 270-day periods: preconceptional, pregnancy, and postpartum. In these periods, we quantified the exposure prevalence to antidepressants overall and stratified by region and use of co-medication. Antidepressants of interest included selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors, Hyperici herba and others. Additionally, we assessed prevalence of antidepressant discontinuation during pregnancy. RESULTS:We included 34,584 pregnancies of whom 1386 (4.0%) were exposed (≥1 claim) to antidepressants preconceptionally, 788 (2.3%) during pregnancy, and 1273 (3.7%) postpartum. Of 1386 women with preconceptional use, 60% had no antidepressant claim during pregnancy. Antidepressant use decreased from 1.6% in trimester one to 1.1% in trimester three. The most frequently dispensed antidepressants during pregnancy were SSRIs (75.0%). Exposure to antidepressants was two-fold higher in the French-speaking region (2.6%) than in Central Switzerland (1.3%). About one-third of women continuing antidepressant treatment during pregnancy also used benzodiazepines (co-medication) at least once during this time. CONCLUSION:4 of 100 women in Switzerland took antidepressants before pregnancy, but 60% discontinued treatment when they became pregnant. Since untreated depression in pregnancy may lead to severe long-term consequences for mother and child, this might be of concern.

Preterm birth (PTB) remains a significant public health concern despite advances in obstetric and neonatal care. Risk screening methods have modest predictive power, primarily because they rely on clinical risk factors that are not present in most women who experience a PTB. Unlike a single disease entity, PTB is a heterogeneous syndrome caused by various genetic, clinical, and environmental factors, and therefore, cannot be predicted by a single marker or risk indicator. For this reason, current risk assessment methods must be shifted from purely clinical indicators to ones that can also capture the underlying biology of the process. This expert opinion piece discusses the current state of risk screening in Europe and the importance of using a 'syndromic' rather than a 'single disease' view of PTB to guide future risk screening. A validated maternal serum biomarker test, marketed in the United States under the tradename PreTRM®, is also discussed as a tool that could potentially help address key shortcomings of risk screening methods, and thereby aid efforts to mitigate PTB, neonatal morbidity and mortality, and their associated costs.

OBJECTIVE:To investigate whether angiogenic biomarkers at term in low-risk pregnancies are associated with the timing of spontaneous and induced labour, and to assess changes from term to post-term gestation. DESIGN:Prospective, non-interventional, observational cohort study. SETTING:Single tertiary care centre, Switzerland. POPULATION:Low-risk term and post-term pregnancies. METHODS:Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured and time intervals from sampling to delivery were analysed in spontaneous (n = 136) and induced labour (n = 48). MAIN OUTCOME MEASURES:Time to spontaneous labour onset and delivery; induction-to-delivery intervals; biomarker changes from term to post-term. RESULTS:In spontaneous labour, higher sFlt-1 levels and sFlt-1/PlGF ratios were inversely correlated with time to delivery (both p = 0.03). The sFlt-1/PlGF ratio remained independently associated with shorter time to delivery after adjustment for gestational age, maternal body mass index, and parity. In induced labour, higher PlGF levels were associated with longer induction-to-delivery intervals (p = 0.02). From term to post-term, PlGF declined (median 208 vs. 148 pg/mL, p < 0.0001), whereas sFlt-1 (median 3128 vs. 3631 pg/mL) and the sFlt-1/PlGF ratio (14 vs. 24) increased (both p < 0.0001). CONCLUSIONS:In low-risk term pregnancies, an anti-angiogenic profile is associated with shorter time to spontaneous delivery and increases from term to post-term consistent with physiological placental maturation. In induced labour, biomarkers reflect placental state but do not independently predict induction dynamics. Their potential role in late-term risk assessment warrants further investigation.

Background/Objectives: Wearable technologies become increasingly important in surveillance of biometric parameters in pregnant women; however, early-stage usability data on wearable form factors specifically designed for pregnant women remain limited. This study evaluated the usability and acceptance of three non-functional wearable garment prototypes intended for future breathing exercise guidance and sleep-related applications. The prototypes incorporated sensor dummies that were technically capable of operation but intentionally deactivated for this usability pilot study. Methods: Eighteen pregnant women (second and third trimester) and twelve non-pregnant women tested three prototypes (Bra, Strap, Maternity Belt (hereafter Belt)) for 24 h. Usability was assessed using structured, participant-completed questionnaires addressing fit, material properties, comfort, and wear-related issues immediately after fitting (T0) and after 24 h of wear (T24). Analyses were descriptive and exploratory. Results: Among pregnant women, the Bra prototype showed consistently favorable usability ratings across multiple domains, particularly after extended wear, whereas the Belt demonstrated declining ratings related to fit and comfort over time. The Strap showed intermediate usability with specific strengths related to pressure and friction. In non-pregnant women, usability ratings were largely comparable between the Bra and Strap, with no clear preference pattern. No systematic differences were observed between pregnant and non-pregnant groups. Conclusions: This exploratory usability study suggests that garment form factor plays a critical role in acceptability during pregnancy. The Bra prototype demonstrated the most favorable usability profile among pregnant women, while the Belt revealed design limitations that warrant further modification. These findings provide formative guidance for the development of functional maternal wearables, with future studies integrating objective testing and validated measures to optimize performance and evaluate adherence in larger cohorts.

(Abstracted from Lancet Diabetes Endocrinol 2025;13:591-599) The incidence rate for gestational diabetes mellitus (GDM) is as high as 14%, making it one of the more common complications of pregnancy. Glycemic control is an important factor in the treatment of GDM and includes self-monitoring of blood glucose (SMBG).

The use of health monitoring software applications (apps) and devices is gaining popularity in obstetrics. The attitude and acceptance of different healthcare professionals regarding telemonitoring during pregnancy and the early phase of labor have not been sufficiently investigated. This study aims to assess healthcare professionals’ views on telemonitoring during pregnancy and childbirth, as well as data processing in the telemonitoring process. The study is part of an international project called `Newlife`, funded by the European Council and nationally funded by the Swiss State Secretariat for Education, Research and Innovation and Innosuisse. Eleven physicians from the fields of obstetrics and neonatology and five prenatal care nurses and five midwives were interviewed. First, participants were asked to fill out a written questionnaire with open and closed-ended answers, containing questions with a 5-point Likert scale. In a second step, a personal oral interview was conducted with all respondents. The study had an exploratory, qualitative focus. Questionnaire responses were summarized using descriptive statistics, while interview recordings were transcribed verbatim and systematically coded to identify recurring themes. Of the respondents (n = 20), five (25.0%) reported previous experience with telemonitoring in their professional practice, and all of them considered it useful. Regarding attitudes and acceptance, 57.1% (n = 12) of respondents would welcome telemonitoring during pregnancy and 52.4% (n = 11) during the early phase of labor, while 33.3% expressed no clear opinion. Rejection of telemonitoring was indicated by 9.6% (n = 2) during pregnancy, and 19.0% (n = 4) during early labor. In terms of perceived benefits, respondents highlighted early detection of problems (n = 13, 61.9%), improved prenatal care (n = 11, 52.4%), and better opportunities for data analysis and research (n = 12, 47.1%). Perceived risks included technical challenges and susceptibility to errors (n = 14, 66.7%), the lack of human contact and personal support (n = 14, 66.7%), and potentially inaccurate measurements (n = 12, 57.1%). This study offers insights into healthcare professionals’ attitudes and acceptance of telemonitoring in healthcare during pregnancy and the early stages of labor. There is a generally positive outlook but concerns and preferences exist. Addressing these considerations is essential for developing effective and user-friendly telemonitoring systems that benefit both healthcare professionals and pregnant women.

STUDY AIMS: A history of gestational diabetes mellitus is a known risk factor for developing type 2 diabetes in the future. Therefore, screening for persistent dysglycaemia in the postpartum period is of utmost importance. However, follow-up rates tend to be low. The aim of this study was to investigate postpartum screening adherence at a tertiary care centre and to identify factors contributing to persistent dysglycaemia. METHODS: A cohort of women with gestational diabetes mellitus diagnosed between 2015 and 2018 at the department of Obstetrics and Gynaecology, University Hospital Bern, Switzerland, was retrospectively studied. Ethnicity, parity, pre-pregnancy BMI, family history of diabetes mellitus, first trimester glycosylated haemoglobin (HbA1c), 75 g oral glucose tolerance test during pregnancy and in the postpartum period were analysed. Postpartum dysglycaemia was defined as overt diabetes (fasting plasma glucose ≥7.0 mmol/l and/or 2 hours plasma glucose ≥11.1 mmol/l for the 75 g oral glucose tolerance test), impaired glucose tolerance (2 hours plasma glucose 7.8–11.0 mmol/l) or impaired fasting glucose (plasma glucose 5.6–6.9 mmol/l). Parametric and non-parametric tests as well as multivariate regression were used. ROC analyses were performed to assess the prognostic accuracy of HbA1c and oral glucose tolerance test results at predicting postpartum dysglycaemia. RESULTS: We included 489 women with gestational diabetes mellitus in our study. Of these, 217 (44.4%) returned for postpartum testing and 59/217 (27.2%) had an abnormal oral glucose tolerance test. Ethnicity was found to be a factor in adherence to follow-up. Specifically, women of African origin showed a significantly higher compliance than Asian or Caucasian women (61.8% vs 47.8% vs 34.5%, respectively; p = 0.04). The multivariate analysis revealed that obesity (OR: 3.64, 95% CI: 1.41–9.37) and first trimester HbA1c >5.7% (OR: 3.67, 95% CI: 1.28–10.52) are significantly associated with an increased risk of postpartum dysglycaemia. CONCLUSION: Our study indicates that adherence to postpartum screening after gestational diabetes mellitus is low but in line with the existing experience. This is of particular concern as 1 of 4 women undergoing postpartum screening show some sort of disturbed glucose metabolism. In particular, women with higher first trimester HbA1c and/or obesity may warrant closer observation and motivation for testing as the risk for persistent metabolic disorders is increased.

We report a case of confusingly high soluble fms-like tyrosine kinase 1/placental growth factor (sFlt1/PlGF) ratio in a pregnant patient with underlying systemic lupus erythematosus and antiphospholipid syndrome without superimposed pre-eclampsia.

Background:Accurate categorisation of the upward rotation of the foetal cerebellar vermis continues to pose diagnostic challenges in prenatal medicine. Recently, a new parameter of the posterior fossa (PF), known as the vermian-crest angle (VCA), has been evaluated using three-dimensional ultrasound (3D-US) and prenatal magnetic resonance imaging (MRI). Objective:This study aimed to evaluate the performance of the VCA in categorizing PF anomalies using 3D-US and to determine its level of agreement with MRI. Study design:We conducted a cohort study involving confirmed cases of PF anomalies. We measured the VCA using 3D-US and compared our data with previously published reference values obtained through both 3D-US and MRI. For statistical analysis, we employed univariate analysis of variance (ANOVA) followed by Tukey's post-hoc test, receiver operating characteristic (ROC) curve analysis, and the intraclass correlation coefficient (ICC). Results:We identified 53 foetuses at a mean gestational age (GA) of 24.5 (SD 5.45) weeks with Blake's pouch cyst (BPC) (n = 11), Dandy-Walker malformation (DWM) (n = 9), mega cisterna magna (MCM) (n = 22), and vermian hypoplasia (VH) (n = 11). Compared to published reference values, the VCA was significantly increased in DWMs (mean 130.6°, SD 16.75°; p ≤ 0.01) and BPCs (mean 91.00°, SD 19.73°; p ≤ 0.05). A VCA > 80.1° distinguished BPCs and DWMs from other PF anomalies, while a VCA > 107° differentiated BPCs from DWMs. When comparing subgroups with published MRI data, we found good agreement between 3D-US and MRI (ICC = 0.71) (95% CI: 0.55-0.87). Conclusion:The VCA may be helpful in categorising PF anomalies using 3D-US, particularly BPC and DWM. The good agreement with MRI measurements reinforces the synergy of these tools in the diagnostic work-up.

PURPOSE:To describe an international response to the COVID-19 pandemic by estimating the prevalence of medication use for COVID-19 treatment in pregnancy, stratified by hospitalization, trimester of pregnancy, and country. METHODS:We conducted a two-stage individual participant data meta-analysis of proportions from primary data on medications used to treat COVID-19 during pregnancy. A common data model was developed to pool the data from single-country and international registries. Data from pregnant individuals with COVID-19 between February 2020 and October 2022 were included in study platforms across 9 data sources. Patient information was abstracted from medical records. RESULTS:Among 24 937 pregnant individuals, the pooled prevalences of individuals receiving medications to treat COVID-19 were: 34.7% heparin, 9.8% antibiotics, 4.9% corticosteroids, 2.2% antivirals, 0.8% antimalarials, 0.3% convalescent plasma, 0.2% immunosuppressants, and 0.02% monoclonal antibodies. Prevalence of medication use was higher in hospitalized individuals than in non-hospitalized individuals: 58.4% versus 17.9% for heparin, 26.9% versus 5.7% for antibiotics, 17.5% versus 1.3% for corticosteroids, 10.3% versus 0.3% for antivirals, and 4.5% versus 0.1% for antimalarials. The prevalence of corticosteroid use was lower in the first trimester (0.1%) compared with the second (7.2%) and third (4.9%) trimesters of pregnancy. The prevalence of medications differed widely across countries. CONCLUSION:Medication to treat COVID-19 was more frequently used in pregnant individuals hospitalized for COVID-19. Corticosteroids were used less in the first trimester of pregnancy. The differences in use between countries could reflect differences in the clinical management and access to medications for this population at risk of severe disease.

BACKGROUND:Preeclampsia is more common in twin pregnancies than in singleton pregnancies. First-trimester combined screening, including maternal risk factors, uterine artery pulsatility index, mean arterial pressure, and placental growth factor, is possible in twin pregnancies. However, the performance is reported to be inferior compared with that in singletons. OBJECTIVE:This study aimed to assess the performance of preeclampsia screening in the first 100 twin pregnancies included in the Implementing Preeclampsia Screening in Switzerland Study cohort in Switzerland. STUDY DESIGN:This is a prospective multicenter registry study performed in Switzerland, including all twin and singleton pregnancies included in the registry with complete screening parameters and outcome data, between June 2020 and June 2024. A total of 3263 singleton and 104 twin pregnancies were included in this analysis. Pregnancies considered at risk for preterm preeclampsia were prescribed low-dose aspirin according to local guidelines. All parameters were converted to multiples of medians by the online calculator on the Fetal Medicine Foundation website (The Fetal Medicine Foundation, Calculators, Research Tools [https://fetalmedicine.org/research/peRisk]). Parameters were compared between singleton, monochorionic, and dichorionic twins. Statistical analysis was performed using GraphPad Prism 10.0 for Windows. Continuous variables were analyzed using the Student t test or Mann-Whitney U-test, whereas proportions were evaluated using the Fisher exact test or chi-squared test and the Kruskal-Wallis test. RESULTS:The incidence of preterm preeclampsia in singleton pregnancies with live births was 29 of 3221 (0.9%) as opposed to 5 of 101 (5.0%) in twins. In uneventful pregnancies, median mean arterial pressure (interquartile range) was significantly higher in monochorionic twins compared with singletons, but not in dichorionic twins (88.5 [85.4-98.0] vs 86.3 [81.0-91.5] mm Hg; P=.005). Median uterine artery pulsatility index (interquartile range) was significantly lower in dichorionic twins compared with singletons and monochorionic twins (1.40 [1.05-1.65] vs 1.50 [1.20-1.9] [P=.0006] and 1.60 [1.35-1.80] [P=.022], respectively). Median PlGF (interquartile range) was significantly higher in dichorionic twins than in singletons, but not in monochorionic twins (55.0 [43.5-79.1] vs 41.0 [31.0-53.8] pg/mL; P<.0001), and median PAPP-A (interquartile range) was significantly higher in both dichorionic and monochorionic twins compared with singletons (9.72 [5.12-14.06] and 6.89 [4.13-11.59] vs 3.25 [1.81-5.15] IU/L [P<.0001], respectively). In twin pregnancies that later developed preterm preeclampsia, PlGF multiples of the median (interquartile range) were significantly lower than in uneventful twin pregnancies (0.52 [0.44-0.81] vs 0.99 [0.67-1.41]; P=.012), whereas all other markers showed no significant difference. At a fixed screen positive rate, significantly more twin pregnancies with preterm preeclampsia were screen-negative than singleton pregnancies with preterm preeclampsia. CONCLUSION:This study demonstrated that, in our cohort, the markers performed as expected in twin compared with singleton pregnancies, and that at a fixed screen positive rate, fewer twin pregnancies with subsequent preeclampsia were detected compared with singleton pregnancies. Our preliminary results showed that a higher cutoff than 1:100, with a corresponding higher screen positive rate, must be chosen when screening for preterm preeclampsia in twin pregnancies to achieve an acceptable detection rate.

Introduction Congenital heart defects (CHD) are the most common malformations. Fetuses with CHD are at an increased risk of being born small for gestational age (SGA), suggesting an impaired placental function. Our aim was to investigate the interdependence between fetal heart and placenta in pregnancies affected by isolated CHD. Methods This was a retrospective cohort study at a tertiary referral center. All singleton pregnancies with suspected fetal CHD between 2009 and 2020 were included. Confirmed CHD were allocated to one of six subgroups according to neonatal echocardiography or autopsy. Birth weight (b), placental weight (p), b/p ratio were calculated and compared between the subgroups, respectively. Results 302 fetuses with confirmed CHD were analyzed. The overall incidence of SGA neonates with isolated CHD was 33/161 (20.4 %), while 28.4 % (38/134) of CHD placental weights were below the 10th percentile, with the highest incidence in cases with isolated univentricular (42.9 %) and left-sided (37.1 %) cardiac lesions. Mean b/p ratio in isolated cases was 5.32 (SD ± 1.51), and 23/134 (17.2 %) were > 90th percentile. 11/302 (3.6 %) of pregnancies were affected by preeclampsia. All neonates were SGA and 7/10 (70 %) placental weights were < 10th percentile. Conclusion The incidence of small placentas, SGA and preeclampsia is increased in pregnancies with fetal CHD. Disturbances in fetal cardio-placental hemodynamics may alter the development of the villous tree resulting in small placentas and fetuses, suggesting a second hit on the placenta, particularly in preeclampsia. Pregnancies with fetal CHD should be followed more closely for placental dysfunction and impaired fetal growth.

INTRODUCTION:Exposure to potentially teratogenic medications during pregnancy is underinvestigated in Switzerland. We aimed to assess exposure to potential teratogens preconceptionally, during the first trimester, and in women of childbearing age, and specifically explore the effectiveness of the valproate pregnancy prevention program (2018). MATERIAL AND METHODS:Retrospective study using the Swiss Helsana claims database. In a pregnancy cohort (2015-2021) and a cohort of women of childbearing age (2021 and 2018), we defined three 90-day time periods: (1) first trimester, (2) preconceptional period (days 180-90 before pregnancy), and (3) January 01, 2021, and March 31, 2021 (women of childbearing age). During all periods, we quantified the exposure prevalence to at least one dispensed weak, proven, and unequivocally potent teratogen overall and by age strata. We quantified the exposure prevalence to each individual teratogen, and to valproate during pregnancy by calendar year to compare its use before and after the introduction of a pregnancy prevention program (2018). We investigated the use of systemic retinoids particularly isotretinoin in women of childbearing age. RESULTS:Of 34 584 pregnant women, 1.4% were exposed to potential teratogens during the first trimester (weak: 1.3%, proven: 0.06%, unequivocally potent: 0.04%). During the preconceptional period, 2.9% were exposed to any teratogen compared to 4.7% of women of childbearing age (Ntotal = 95 059). Systemic glucocorticoids were the most prevalent weak teratogens during all time periods (75% of all claimed teratogens during the first trimester). In the first trimester, the antibiotic cotrimoxazole and the thyreostatic thiamazole (weak teratogens), ranked second and third, followed by the antiseizure medications carbamazepine and topiramate (proven teratogens). Among women of childbearing age, exposure to weak and proven teratogens increased with age, whereas exposure to unequivocally potent teratogens decreased with age. This was due to 2.3% of women <26 years who claimed systemic isotretinoin. Valproate use during pregnancy decreased after the introduction of a pregnancy prevention program (2.39/10 000 pregnancies [2015-2018] vs. 0.93/10 000 pregnancies [2019-2021]). CONCLUSIONS:Most medications with potential teratogenic effects dispensed to women of childbearing age and pregnant women were in the group of weak teratogenicity level, and many women discontinued treatment before pregnancy. Preliminary evidence suggests the valproate pregnancy prevention program in Switzerland may be beneficial.

IntroductionSwitzerland was amongst the first countries to offer cell-free fetal DNA (cffDNA) testing covered by the health insurance to pregnant women with a risk >= 1:1000 for trisomies at first trimester combined screening (FTCS). The aim of this study is to evaluate the implementation of this contingent model in a single tertiary referral centre and its effect on gestational age at diagnosing trisomy 21.Materials and MethodsBetween July 2015 and December 2020 all singleton pregnancies at 11-14 weeks of gestation without major fetal malformation were included and stratified according to their risk at FTCS. Statistical analysis was performed by GraphPad Version 9.1 for Windows.Results4424 pregnancies were included. Of 166 (3.8%) pregnancies with a NT >= 3.5 mm and/or a risk >= 1:10 at FCTS, 130 (78.3%) opted for direct invasive testing. 803 (18.2%) pregnancies had an intermediate risk, 692 (86.2%) of them opted for cffDNA first. 3455 (78.1%) pregnancies had a risk < 1:1000. 63 fetuses were diagnosed with trisomy 21, 47 (74.6%) directly by invasive procedures after FTCS, 16 (25.4%) by cffDNA first.ConclusionsMost women choose cffDNA or invasive testing as second tier according to national guidelines. Despite the delay associated with cffDNA testing after FCTS, 75% of all trisomy 21 are still diagnosed in the first trimester with this contingent screening model.

BACKGROUND:The increasing demand for umbilical cord blood (UCB) used in stem cell transplantation led to the establishment of cord blood (CB) banks worldwide. These include public foreign donor banks and private family-directed donor banks. Recently, our department has introduced a third banking model within a private-public-partnership. This hybrid banking allows for storage of family-directed CB units, while also getting Human leukocyte antigen (HLA)-typed and included in the national stem cell donor registry. So if the need arises, the HLA-compatible CB unit can be released to an unrelated recipient as a foreign donor stem cell graft. OBJECTIVES:The aim of this study was to evaluate women's perspectives on the different CB banking options as well as retrospective satisfaction with their decisions. METHODS:We performed a prospective survey study in postpartum women, using a validated questionnaire. RESULTS:A total of 157 women were included in this survey study; 68% of them decided to have their UCB stored or donated. Among those women, 25% of them opted for hybrid storage, 72% of respondents stored UCB publicly, and 3% decided for private family-directed storage. CONCLUSIONS:Our study shows the potential of hybrid banking as an attractive UCB storage option, as an alternative to family-directed banking rather than a substitute for public donation. Hybrid storage potentially combines advantages of family-directed banking as well as unrelated CB donation expanding the number of registered CB units available for transplantation and giving every pregnant woman the possibility to store UCB.